Devert-50/Devert-100 Dosage/Direction for Use

The recommended dose of is 50 mg once daily with or without food. The 50 mg dose is both a starting dose and the therapeutic dose. Desvenlafaxine succinate monohydrate tablet must be taken at approximately same time each day. Do not chew, open or crush tablets. In clinical studies, doses of 50-400 mg/day have been shown to be effective, though no other benefit was demonstrated at doses greater than 50 mg/day and adverse reactions and discontinuations were more frequent at higher doses. The maximum dose should not exceed 200 mg/day. Gradual reduction in dose is recommended when discontinuing treatment may minimize discontinuation symptoms. The dose intended for a gradual reduction when discontinuing treatment is 25 mg per day to minimize discontinuation symptoms.
Use in Patients with Renal Insufficiency: The recommended starting dose in patients with severe renal impairment (CrCl 15 to 29 mL/min) or end-stage renal disease (ESRD) is 50 mg every other day, for patients with moderate renal impairment (CrCl 30 to 50 mL/min) is 50 mg every day. Additional doses should not be administered to patients after dialysis.
Use in Patients with Liver Failure: No dosage adjustment is necessary for patients with hepatic impairment. However, the escalation of doses above 100 mg/day is not recommended.
Pediatric Use: The safety and efficacy in patients under 18 years of age have not been established.
Elderly Use: No dose adjustment is necessary based solely on age; however, a possible decrease in renal clearance of Desvenlafaxine should be considered when determining the dose to be used. Greater risk for hyponatremia as adverse event is clinically significant.
Discontinuation of Desvenlafaxine: Symptoms associated with the discontinuation of desvenlafaxine, as well as other SNRIs and SSRIs, have been reported. A gradual reduction in dose rather than abrupt cessation is recommended whenever possible. If the patient experiences intolerable symptoms after a dose reduction or discontinuation of treatment, resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose, but at a more gradual rate.
Substitution of Treatment from Other Antidepressants to Desvenlafaxine: Withdrawal symptoms have been reported when the treatment of patients with other antidepressants, including venlafaxine, is replaced by treatment with desvenlafaxine. The gradual discontinuation of the initial antidepressant may be necessary to minimize discontinuation symptoms.
Substitution to or from MAOI (monoamine oxidase inhibitor) for Treating Psychiatric Disorders: At least 7 days should be allowed after stopping Desvenlafaxine before starting therapy on MAOI for treating psychiatric disorders and at least 14 days should elapse between discontinuing MAOI and initiating therapy of Desvenlafaxine.
Use of desvenlafaxine with Reversible MAOI (Linezolid or Methylene blue): Do not start desvenlafaxine in a patient being treated with a reversible MAOI such as linezolid, or in patients whom intravenous methylene blue was administered because of the increased risk of serotonin syndrome. In a patient who requires a more urgent treatment of a psychiatric condition, nonpharmacological interventions, including hospitalization, should be considered. In some cases, a patient who is already receiving therapy with desvenlafaxine may need urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives for the treatment with linezolid or methylene blue intravenously are not available and the potential benefits of treatment with linezolid or methylene blue intravenous outweigh the risk of serotonin syndrome in a specific patient, desvenlafaxine should be stopped immediately, and linezolid or methylene blue may be administered intravenously. The patient should be monitored for symptoms of the syndrome serotonin for two weeks or until 24 hours after the last dose of linezolid or methylene blue intravenously, whichever comes first. Desvenlafaxine therapy can be resumed 24 hours after the last dose of linezolid or intravenous methylene blue.